Provider Demographics
NPI:1710008966
Name:GHALAMBOR, OLIVER (MD)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:
Last Name:GHALAMBOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 STATE HIGHWAY 121 STE 4150
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6150
Mailing Address - Country:US
Mailing Address - Phone:972-872-8408
Mailing Address - Fax:972-850-7352
Practice Address - Street 1:981 STATE HIGHWAY 121 STE 4150
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6150
Practice Address - Country:US
Practice Address - Phone:972-872-8408
Practice Address - Fax:972-850-7352
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ7044207L00000X, 208VP0014X, 207R00000X
IL036114432208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114432Medicaid
ILK51524Medicare PIN